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Inferior Vena Cava Filters in the Elderly

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Authors:  Bikdeli B et al. 

JAMA Intern Med 2018 Dec 10

In analyses of observational data on Medicare patients, IVC filters are associated with greater 30-day and 1-year mortality.

Data on the benefits of inferior vena cava (IVC) filters in elderly patients with pulmonary embolism (PE) are mixed. These researchers used three statistical approaches to explore the association between placement of IVC filters and mortality. They analyzed observational data on 214,579 Medicare patients aged ≥65 and hospitalized for PE from 2011 to 2014; 13.4% received an IVC filter.

Patients with IVC filters experienced higher 30-day and 1-year mortality (11.6% and 20.5%, respectively) than those who did not receive an IVC filter (9.3% and 13.4%). In a model using mixed effects regression adjustment, the two groups had no significant difference in 30-day mortality. However, in analyses using an inverse probability weighted adjustment and in an individually matched cohort, mortality was significantly higher in patients who received IVC filters. All models showed significantly higher 1-year mortality for patients with IVC filters.

COMMENT

This observational study uses several statistical methods to attempt to control for confounding that could affect the relationship between IVC filters and mortality. Patients receiving IVC filters after PE tend to be sicker than those who do not get IVC filters and might have a contraindication to anticoagulation; this residual bias is likely to persist despite optimal statistical adjustments. It is surprising that despite unclear benefit, 13% of elderly patients received an IVC filter following a PE. In sum, these findings should cause clinicians to pause before recommending IVC filters in elderly patients following PE. As the authors note, more data from randomized, clinical trials are needed to confirm these findings and to identify which limited patient subgroups might benefit from IVC filters.

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